Provider Demographics
NPI:1780634774
Name:DEYOE, CAROLE (RPH)
Entity Type:Individual
Prefix:
First Name:CAROLE
Middle Name:
Last Name:DEYOE
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 N SHORE RD
Mailing Address - Street 2:PO BOX 446
Mailing Address - City:CAROGA LAKE
Mailing Address - State:NY
Mailing Address - Zip Code:12032-5517
Mailing Address - Country:US
Mailing Address - Phone:518-835-2498
Mailing Address - Fax:518-835-2498
Practice Address - Street 1:2 E MAIN ST
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:NY
Practice Address - Zip Code:12095-2623
Practice Address - Country:US
Practice Address - Phone:518-762-8319
Practice Address - Fax:518-762-5272
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY042843183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist